Comparison of dextran 40 with albumin and Ringer's lactate as components of perfusion prime for cardiopulmonary bypass in patients undergoing myocardial revascularization

Abstract

A major expense for the conduct of cardiopulmonary bypass in many institutions is the cost of 5% albumin. Potential advantages in using dextran 40 as the colloid component of the priming solution for cardiopulmonary bypass include decreased cost and less viscosity in the microcirculation. Possible disadvantages include bleeding and anaphylactic reactions. From August 1985 to February 1986, 60 consecutive patients undergoing elective myocardial revascularization were prospectively randomized to receive either 5% albumin ( N = 29) or dextran 40 (N = 31) as the colloid component of the priming solution for cardiopulmonary bypass. Twenty matched patients also underwent revascularization with the prime consisting only of Ringer's lactate solution. There were no differences among the three groups for age, sex, size, crossclamp time, cardiopulmonary bypass time or number of coronary artery bypass grafts performed. In all three groups important postoperative changes were noted in platelet count, bleeding time, thrombin time, prothrombin time, fibrinogen and fibrin split products. Complement levels (C5a) were elevated in the dextran group (p = 0.03). Postoperative crystalloid (p = 0.04) and colloid (p = 0.0001 ) requirements were increased in the Ringer's lactate group and there was a significant weight gain (p = 0.0001). Colloid osmotic pressure was highest in the dextran group during (p = 0.0001) and after bypass (p = 0.001). There was no difference in clinical events and no hospital deaths. In conclusion, we found dextran to be a safe colloid for use as prime in uncomplicated coronary artery bypass grafting patients. The cost of dextran prime was substantially less than for albumin prime. A purely crystalloid prime is discouraged because of a tendency for fluid retention.